Volunteer Release & Waiver Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

EMERGENCY CONTACT INFO

Emergency Contact Full Name *

Emergency Contact Phone Number *

Relation to Emergency Contact *

ADDITIONAL INFORMATION

Are you attending a team building event or with a specific group?

Are you attending a team building event or with a specific group? *

Yes
No

If yes, please provide the company or group name.

How did you hear about Hope Blooms? *

RELEASE & WAIVER INFO

VIEW RELEASE AND WAIVER OF LIABILITY

This is a legal binding document. Please read it in its entirety. This Release and Waiver of Liability (the “Release”) executed by (the “Volunteer”) in favor of Hope Blooms, a non-profit corporation, their directors, officers, employees, agents andaffiliates. The Volunteer desires to work as a volunteer for Hope Blooms and engage in the activities related to being a volunteer at Hope Blooms (“Activities”), which may include pickup, processing and delivery of flowers, floral arrangements, and jars/vessels in the area served by Hope Blooms. The Volunteer hereby freely, voluntarily, and without duress executes this Release under the following terms:

Release and Waiver: The Volunteer does hereby waive, release and forever discharge and hold harmless Hope Blooms and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, that the Volunteer (or the Volunteer’s heirs or assigns) may have against Hope Blooms, which arise or may hereafter arise from Volunteer’s Activities with Hope Blooms. Volunteer understands that this Release discharges Hope Blooms from any liability or claim that the Volunteer may have against Hope Blooms with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Volunteer’s Activities with Hope Blooms, whether caused by the negligence of Hope Blooms or its officers, directors, employees, or agents or otherwise. Volunteer also understands that the scope of the Volunteer’s relationship with Hope Blooms is limited to a volunteer position and that no compensation is expected in return for services provided by the Volunteer; that Hope Blooms will not provide any benefits traditionally associated with employment to the Volunteer; and that the Volunteer is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of the Volunteer’s services to Hope Blooms.

Insurance: The Volunteer understands that Hope Blooms does not carry or maintain health, medical, or disability insurance, and that Hope Blooms does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to, medical, health, or disability insurance or medical expense reimbursement in the event of injury or illness, or damage to my property. Volunteer expressly waives any such claim for compensation or liability on the part of Hope Blooms in the event of such injury or medical or property expenses incurred by me. In the event Volunteer uses his/her personal vehicle for Activities related to a volunteer project of Hope Blooms, including the pick up or delivery of flowers, the vehicle shall be properly insured. Volunteer understands that Volunteer’s insurance is the primary insurance, and further understands that Hope Blooms will not pay for damage to Volunteer’s personal vehicle or bear responsibility for any other property damage or bodily injuries that may result from the use of the vehicle for volunteer service for Hope Blooms. Upon request, Volunteer hereby agrees to provide Hope Blooms with verification of Volunteer’s valid driver’s license, vehicle registration and proof of insurance.

Medical Treatment: Volunteer does hereby release and forever discharge Hope Blooms from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered by Hope Blooms or any other provider in connection with the Volunteer’s Activities with Hope Blooms.

Assumption of the Risk: Volunteer hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases Hope Blooms from all liability for injury, illness, death, or property damage resulting from the Activities.

Political or Religious Activities: Volunteers shall not engage in political or religious activities while performing the Activities on behalf of Hope Blooms.

Photographic/Video and Testimonial Release: Volunteer does hereby grant Hope Blooms all rights and permissions to use Volunteer’s testimonial, picture, video and audio recording for any public relations efforts in conjunction with the organization, without compensation. Volunteer understands and agrees these items will become the property of Hope Blooms and any royalties, proceeds, or other benefits derived from such photographs or recordings.

North Dakota Law: Volunteer expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of North Dakota and that this Release shall be governed by and interpreted in accordance with the laws of the State of North Dakota. Volunteer agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. I am of legal age and am freely signing this agreement. I have carefully read this agreement and fully understand its contents. I am aware that by signing this release of liability, I am forfeiting any legal rights and remedies.

I agree to the terms and conditions outlined above.

Please sign your name as acknowledgement of the terms of volunteering and all information provided is accurate.

Date *

Is the volunteer under 18 years old? *

Parent/Guardian Name (if volunteer is under 18)

Parent/Guardian Typed Signature*

*By typing your name into this field, you are giving the minor in your care consent to volunteer at Hope Blooms and agree to the terms outlined above.